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A major new report about colorectal cancer found that a number of lifestyle factors (diet, physical activity) increase or lower the risk of colorectal cancer. The report was an analysis of global research studies and was published by the American Institute for Cancer Research and World Cancer Research Fund.

They found that there is strong evidence that: being physically active, consuming whole grains, consuming foods containing dietary fiber, consuming dairy products, and taking calcium supplements all decrease the risk of colorectal cancer. On the other hand, there is strong evidence that: consuming red meat, consuming processed meat, consuming 2 or more alcoholic drinks per day, being overweight or obese, and being tall all increase the risk of colorectal cancer.

Also, that there is some evidence that: consuming foods containing vitamin C, consuming fish, vitamin D, consuming multivitamin supplements lower the risk of colorectal cancer. And there is some evidence that: low consumption on non-starch vegetables, low consumption of fruit, and consumption of foods containing haem iron might increase the risk of colorectal cancer. [NOTE: There are 2 types of iron in food: haem and non-haem iron. Haem iron is only found in meat, chicken, and fish, and is easily absorbed. Non-haem iron is found in plant foods, such as vegetables, cereals, beans, and lentils, but is not absorbed as well by the body.]

Finally, their cancer prevention recommendations for preventing cancer in general include: maintaining a healthy weight, being physically active and eating a healthy diet. (other posts on this - here, here, here). They also advise eating a healthy diet (think Mediterranean style diet) rather than relying on supplements to protect against cancer. The report also noted that inflammatory bowel disease and smoking increase the risk of colorectal cancer. From Science Daily:

Whole grains decrease colorectal cancer risk, processed meats increase the risk

Eating whole grains daily, such as brown rice or whole-wheat bread, reduces colorectal cancer risk, with the more you eat the lower the risk, finds a new report by the American Institute for Cancer Research (AICR) and the World Cancer Research Fund (WCRF). This is the first time AICR/WCRF research links whole grains independently to lower cancer riskDiet, Nutrition, Physical Activity and Colorectal Cancer also found that hot dogs, bacon and other processed meats consumed regularly increase the risk of this cancer. There was strong evidence that physical activity protects against colon cancer.

The new report evaluated the scientific research worldwide on how diet, weight and physical activity affect colorectal cancer risk. The report analyzed 99 studies, including data on 29 million people, of whom over a quarter of a million were diagnosed with colorectal cancer.

Other factors found to increase colorectal cancer include:  - Eating high amounts of red meat (above 500 grams cooked weight a week), such as beef or pork, - Being overweight or obese, - Consuming two or more daily alcoholic drinks (30 grams of alcohol), such as wine or beer. The report concluded that eating approximately three servings (90 grams) of whole grains daily reduces the risk of colorectal cancer by 17 percent. It adds to previous evidence showing that foods containing fiber decreases the risk of this cancer.

In the US, colorectal cancer is the third most common cancer among both men and women, with an estimated 371 cases diagnosed each day. AICR estimates that 47 percent of US colorectal cancer cases could be prevented each year through healthy lifestyle changes[The report.]

Another study finding that diet (what one eats) can work just as well as medications for a health condition - this time for one form of acid reflux disease. The researchers found that a Mediterranean style diet worked just as well as, and actually worked better, than medications for laryngopharyngeal reflux (LPR). They think these beneficial results will also work for gastroesophageal reflux disease (GERD). The plant-based Mediterranean diet (lots of fruits, vegetables, legumes, whole grains, seeds, nuts, olive oil, more fish and less meat) in the study has lots of other health benefits, while common medications (proton pump inhibitors - PPI) for reflux have many side effects, including very serious ones with prolonged use (stroke, heart attack, dementia, kidney damage).

It must be noted that the Mediterranean style diet group was also told to drink alkaline water, and both groups were told to follow "standard reflux precautions" (no coffee, tea, chocolate, soda, greasy, fried, fatty and spicy foods, and alcohol). However, the researchers point out that " prior studies have demonstrated little clinical change in reflux incidence with these lifestyle approaches" - meaning both groups in this study were told to follow standard reflux precautions, even though prior studies showed there was no benefit in doing so. (So why did they have the people follow them?)

Many studies have found numerous health benefits from a Mediterranean style diet, but it is unclear whether alkaline water has any health benefits, and the only study the researchers mention about alkaline water and GERD was done in laboratory tests (on cells), rather than in humans - so we really don't know (need studies!). Perhaps only a Mediterranean style diet is sufficient to treat acid reflux disease? Bottom line: dietary changes work best, benefits occur quickly (within a few weeks), and have many health benefits - therefore try them first in treating reflux symptoms. From Medical Xpress:

Mediterranean-style diet may eliminate need for reflux medications

A plant-based, Mediterranean-style diet has been shown to provide the same medical benefits for treating laryngopharyngeal reflux as popular reflux medications. .... When compared to patients who took the traditional reflux medication, proton pump inhibitors (PPI), those patients who consumed a 90-95% whole food, plant-based, Mediterranean-style diet paired with alkaline water had the same if not better reduction in reflux symptoms. 62.6 percent of patients treated with a plant-based diet and alkaline water saw a six point reduction in their Reflux Symptom Index (RSI - a measurement for the severity of reflux symptoms), compared to 54.1 percent reduction in patients taking PPI's.

Though this research only focused on those with laryngopharyngeal reflux, this same diet regimen has implications to help patients with gastro-esophageal acid reflux (also known as GERD). Lead author of the study, Craig H. Zalvan, MD, FACS, chief of Otolaryngology and medical director of The Institute for Voice and Swallowing Disorders at Northwell Health's Phelps Hospital and researcher at the Feinstein Institute, said he was formerly one of the largest prescribers of PPI's in the region. Feeling that there had to be a better approach to treating reflux conditions like laryngopharyngeal reflux, he started to research alternatives. "Although effective in some patients, I felt medication couldn't be the only method to treat reflux and recent studies reporting increased rates of stroke and heart attack, dementia and kidney damage from prolonged PPI use made me more certain," said Dr. Zalvan. 

The diet suggested by Dr. Zalvan consists of mostly fruits, vegetables, grains and nuts with near complete cessation of dairy and meats including beef, chicken, fish, eggs and pork. This is in addition to standard reflux diet precautions like avoiding coffee, tea, chocolate, soda, greasy and fried food, spicy foods, fatty foods and alcohol. Along with relieving reflux symptoms, Dr. Zalvan noted that many of his patients who were treated with a plant-based diet also experienced some weight loss and a reduction of symptoms and medication use from other medical conditions like high blood pressure and high cholesterol. Dr. Zalvan said that a plant-based diet approach with alkaline water and standard reflux precautions should either be attempted prior to the use of medication or with the short-term use of medication for more severe needs. [Original study.]

It seems like I can't stop writing about coffee (here and here). Coffee drinkers rejoice: another study (presented at the European Society of Cardiology) finds health benefits from drinking several cups of coffee daily. This study, like other previous studies, found an inverse relationship between drinking coffee and early death ("all-cause mortality") - meaning the more one drinks coffee, the less likely one is to have a premature death. The biggest effect was in drinking 4 cups daily in people aged 45 and older! It was an observational study, so can't prove it definitely - can only say there's an association. But still... it's looking good. From Medical Xpress:

Higher coffee consumption associated with lower risk of death

Higher coffee consumption is associated with a lower risk of death, according to research presented today at ESC Congress. The observational study in nearly 20,000 participants suggests that coffee can be part of a healthy diet in healthy people. 

The purpose of this study was to examine the association between coffee consumption and the risk of mortality in a middle-aged Mediterranean cohort. The study was conducted within the framework of the Seguimiento Universidad de Navarra (SUN) Project, a long-term prospective cohort study in more than 22,500 Spanish university graduates which started in 1999. This analysis included 19,896 participants of the SUN Project, whose average age at enrollment was 37.7 years old. .... Patients were followed-up for an average of ten years. 

During the ten year period, 337 participants died. The researchers found that participants who consumed at least four cups of coffee per day had a 64% lower risk of all-cause mortality than those who never or almost never consumed coffee. There was a 22% lower risk of all-cause mortality for each two additional cups of coffee per day.

The researchers examined whether sex, age or adherence to the Mediterranean diet had any influence on the association between baseline coffee consumption and mortality. They observed a significant interaction between coffee consumption and age. In those who were at least 45 years old, drinking two additional cups of coffee per day was associated with a 30% lower risk of mortality during follow-up. The association was not significant among younger participants.

Image result for calcium rich foods, wikipediaAgain, another study finds that taking supplements is not always best for health. Many studies find that eating foods with vitamin "X" is beneficial, but taking high dose supplements may be linked to health problems (here, here, and here). Now a new study finds that long-term high dose supplementation with vitamins B6 and B12 is associated with a 30 to 40% higher lung cancer risk in men (compared to men who didn't take these supplements). Smokers had the greatest increase in risk. But interestingly, long-term use use of  vitamins B6, folate, and B12 was not associated with lung cancer risk among women.

Good food sources of vitamin B6 are: poultry, fish, organ meats, potatoes and other starchy vegetables, chickpeas, and fruit (but not citrus). Good food sources of B12 are:  Beef liver, clams, fish, meat, poultry, eggs, milk, and other dairy products.  Bottom line: if you take vitamin supplements (such as daily multi-vitamin supplements), take a "low-dose" one - one that aims for 100% of minimum daily requirements, but not mega-doses of vitamins.  From Medical Xpress:

Clear link between heavy vitamin B intake and lung cancer

New research suggests long-term, high-dose supplementation with vitamins B6 and B12—long touted by the vitamin industry for increasing energy and improving metabolism—is associated with a two- to four-fold increased lung cancer risk in men relative to non-users.

Risk was further elevated in male smokers taking more than 20 mg of B6 or 55 micrograms of B12 a day for 10 years. Male smokers taking B6 at this dose were three times more likely to develop lung cancer. Male smokers taking B12 at such doses were approximately four times more likely to develop the disease compared to non-users..... This is the first prospective, observational study to look at the effects of long-term high-dose B6/B12 supplement use and lung cancer risk. These supplements have been broadly thought to reduce cancer risk.

For this study, Theodore Brasky, PhD, of the OSUCCC - James, and colleagues analyzed data from more than 77,000 patients participants in the VITamins And Lifestyle (VITAL) cohort study, a long-term prospective observational study designed to evaluate vitamin and other mineral supplements in relation to cancer risk. All participants were aged between 50 and 76 were recruited in the state of Washington between the years 2000 and 2002. Upon enrolling in the study, participants reported information to researchers about B-vitamin usage over the past 10 years. This included dosage information.

Brasky notes these findings relate to doses that are well above those from taking a multivitamin every day for 10 years. "These are doses that can only be obtained from taking high-dose B vitamin supplements, and these supplements are many times the U.S. Recommended Dietary Allowance," he said. Two additional studies are underway at The OSUCCC - James to further evaluate high dose, long-term B6 and B12 supplementation and lung cancer risk. [Original study.]

  Amazing if this holds up in larger studies - a treatment for peanut allergy! As the researchers said -  the treatment (2 grams of peanut protein plus a specific strain of the probiotic Lactobacillus rhamnosus daily for 18 months) provided "persistent suppression of the allergic immune response to peanuts 4 years" after the treatment had ended This was a nicely done multi-year study in children - a randomised, double-blind, placebo-controlled trial (to eliminate biases).

The researchers also wrote in the Discussion section of the study: "PPOIT [combined probiotic and peanut oral immunotherapy] was associated with long-lasting peanut tolerance 4 years after stopping treatment. Two-thirds of PPOIT treated participants were able to continue regular peanut ingestion, and more than half were ingesting moderate to-large amounts of peanut on a regular basis, compared with only one (4%) of 24 placebo-treated participants. Allergic reactions from intentional peanut ingestion were uncommon and all reactions were mild, suggesting that those who achieved PPOIT-induced sustained unresponsiveness can safely continue peanut ingestion." In other words - WOW! (Other posts on peanut allergies - here and here, and earlier progress report of this study.) From Medical Xpress:

Australian researchers in peanut allergy breakthrough

Australian researchers have reported a major breakthrough in the relief of deadly peanut allergy with the discovery of a long-lasting treatment they say offers hope that a cure will soon be possible. In clinical trials conducted by scientists at Melbourne's Murdoch Childrens Research Institute, children with peanut allergies were given a probiotic along with small doses of a peanut protein over an 18-month period. When the experiment ended in 2013 some 80 percent of the kids were able to tolerate peanutsThe research, published Wednesday in medical journal The Lancet, found that four years on, about 70 percent could still eat peanuts without an adverse reaction.

"The importance of this finding is that these children were able to eat peanuts like children who don't have peanut allergy and still maintain their tolerant state, protected against reactions to peanut," lead researcher Mimi Tang said. "These findings suggest our treatment is effective at inducing long-term tolerance, up to four years after completing treatment, and is safe. Food allergy affects one in 20 children and about two in 100 adults, with seafood, cow's milk, eggs and peanuts among the most typical triggers. Peanuts are one of the most common foods to cause anaphylaxis, a potentially fatal allergic reaction.

The researchers said the Murdoch study provides the "strongest evidence yet that a cure may be possible for peanut allergy"..... Ten-year-old Olivia May suffered a reaction when she tried to eat a peanut butter sandwich seven years ago. "We visited the allergist the first time [and] he said 'sorry, you're going to have to go home and empty your pantry out, clear it of all nuts, anything with nuts in it'," Oliver's mother Tanya told the Australian Broadcasting Corporation. But after taking part in the trial, Oliva no longer suffers from her allergy.

Fifty-six children completed the study, with half receiving a placebo and half receiving the treatment, which encourages the immune system to develop a tolerance to the allergy. Researchers are now aiming to confirm the results with a larger study of the treatment they say "holds important implications for attacking the modern food allergy epidemic". [Original study.]

   Is "fat but fit" a myth or true? The results of this study suggest that it is a myth. That there is a higher risk of coronary heart disease, and even if everything looks OK initially, it is associated with an eventual metabolic changes (and problems). Just wait a while - as can be seen in the results of this study that followed people from 8 European countries over many years (about 12.2 years). The study found that being normal weight and fit is best, and that "metabolically healthy" obese people were more likely to go on to develop metabolic abnormalities (and become metabolically unhealthy obese people) over the years. Metabolically unhealthy signs included high blood pressure, low HDL-cholesterol, and hyperglycemia (high blood sugar).

Bottom line: aim for normal weight for a lower risk of heart disease (and of course, be physically active and eat a healthy diet - fewer processed foods, and more fruits, vegetables, whole grains, seeds, nuts, and legumes). From Science Daily:

'Fat but fit' are at increased risk of heart disease

Carrying extra weight could raise your risk of heart attack by more than a quarter, even if you are otherwise healthy.Researchers have found that being overweight or obese increases a person's risk of coronary heart disease (CHD) by up to 28 per cent compared to those with a healthy body weight, even if they have healthy blood pressure, blood sugar and cholesterol levels.The findings add to a growing body of evidence that suggests being 'fat but fit' is a myth, and that people should aim to maintain a body weight within a healthy range.

Storing too much fat in the body is associated with a number of metabolic changes, including increased blood pressure, high blood sugar and altered cholesterol levels, which can lead to disease and poor health. However, previous studies have revealed a subset of overweight people who appear to lack the adverse health effects of excess weight, leading to them being classified as 'metabolically healthy obese' in the medical literature, and 'fat but fit' in the media.

Now, a group led by researchers at Imperial College London and the University of Cambridge has shown that despite an apparent clean bill of health, this overweight group is still at increased risk compared to those with a healthy weight. In the largest study of its kind to date, scientists used data from more than half a million people in 10 European countries -- taken from the European Prospective Investigation into Cancer and Nutrition (EPIC) -- to show that excess weight is linked with an increased risk of heart disease, even when people have a healthy metabolic profile.

In the study, published in the European Heart Journal, researchers looked at the link between excess weight and risk of CHD, a condition where not enough blood gets through to the heart due to clogged arteries, leading to heart attacks. After a follow-up period of more than 12 years, a total of 7,637 people in the EPIC cohort experienced CHD events, such as death from heart attack. Researchers then selected a representative group of more than 10,000 individuals as controls, for analysis. Body weight was classified according to definitions from the World Health Organization. Those with a body mass index (BMI) over 30 were classed as obese, while those with a BMI of 25-30 were classed as overweight, and 18.5-25 as normal weight. More than half of the control group (63 per cent) were female, with an average age of 53.6 and an average BMI of 26.1.

Participants were categorised as 'unhealthy' if they had three or more of a number of metabolic markers, including high blood pressure, blood glucose, or triglyceride levels, low levels of HDL cholesterol, or a waist size of more than 37" (94 cm) for men and 31" (80 cm) for women. .... the researchers found that compared to the healthy normal weight group, those classed as unhealthy had more than double the risk of CHD, whether they were normal weight, overweight or obeseHowever, analysis also revealed that within the apparently healthy group there was a significant difference in outcomes for people depending on their weight. The research found that compared to those at normal weight, people who were classified as healthy but were overweight had an increased CHD risk of 1.26 (26 per cent), while those who were healthy but obese had an increased risk of 1.28 (28 per cent). [Original study.]

Mediterranean Diet is Healthy Eating – A Good Option for Seniors So, how many of you have had doctors discuss nutrition with you? How about your cardiologist? "No"...many of you answer. Well, that shouldn't be surprising according to a new survey of 930 cardiologists, cardiologists-in-training, and cardiovascular health professionals. Among practicing cardiologists, fully 90% reported that they received either no or minimal nutrition education during their cardiology training. And currently there is no requirement that nutrition needs to be taught in cardiology training. Most also reported that they spend less than 3 minutes discussing nutrition per appointment. What does that really mean? Is it just a few words like: lose weight, eat better, and eat less salt? That's not enough to be real nutrition advice.

Why is nutrition important? Among the top 17 risk factors, poor diet quality has been identified by the US Burden of Disease Collaborators as the leading cause of premature deaths and disability in the United States. Heart health is influenced by the diet. Many studies have shown that people following such healthy diets as the Mediterranean diet (with an emphasis on fruits, vegetables, whole grains, seeds, nuts, legumes, and olive oil) have a significantly lower incidence of heart disease and major cardiovascular events (especially strokes). One recent study (an analysis of other studies) linked eating 8 to 10 portions of fruits and vegetables daily with a lower risk of early death, cancer, heart disease, and stroke. From Medscape:

Cardiologists Are Hungry for Knowledge on Nutrition

Hello. My name is Dr Stephen Devries and I'm a cardiologist and executive director of the nonprofit Gaples Institute for Integrative Cardiology. It's a pleasure to have an opportunity to share with you some interesting findings related to a new study I was involved in regarding nutrition education in cardiology. I'm sure you are aware that patients increasingly want to take more charge of their own health. In order to do so, they are asking their doctors more questions about nutrition. But how prepared are physicians to address those questions? Specifically, we asked: How prepared are cardiologists to deal with nutrition questions in their own practice?

In order to get at that question, my colleagues and I, members of the Nutrition Working Group of the American College of Cardiology, surveyed[1] over 900 practicing cardiologists, cardiologists-in-training, and cardiovascular health professionals and asked them a wide range of questions relating to their experience with nutrition education, their attitudes about nutrition and practice, and a little bit about their own personal nutrition habits.

What did we find? Among practicing cardiologists, fully 90% reported that they received either no or minimal nutrition education during their cardiology training. When we inquired a bit about their attitudes regarding nutrition and practice, 95% of cardiologists reported that they believed it was their personal responsibility to deliver at least basic nutrition education to their patients. We were a bit surprised. We had wondered whether cardiologists felt that it was someone else's job to do; but no, they felt that it was their own personal responsibility to at least deliver basic diet counseling to their patients.

We then asked cardiologists about their own personal health habits and inquired about their personal intake of vegetables and fruit. We found that only 20% of practicing cardiologists reported eating a total of five or more servings of vegetables and fruit per day. That is an important finding, not only because it speaks to opportunities to improve cardiologists' own health, but also because there are data[2] showing that physicians who adopt healthy lifestyle practices are more likely to counsel patients to do so as well.

Where do we go from here? It's paradoxical that nutrition and lifestyle are identified in many of our clinical care guidelines as the foundations of good cardiovascular care, yet how can our cardiologists implement those guidelines without receiving adequate nutrition training? Obviously, we need to address that problem by providing meaningful nutrition education in all phases of medical training, beginning in medical school through internal medicine residency, and extending into cardiovascular training itself. Currently there is no requirement that nutrition needs to be taught in cardiology training—and that needs to change. We also should include more nutrition content on board exams so that there will be additional motivation to teach nutrition to help pass the exam.

2

Image result for lobster meal wikipedia A recent study provided evidence that higher levels of cadmium in women may increase the risk of endometrial cancer. Endometrial cancer is the fourth most common cancer in women, and it occurs primarily in postmenopausal women. Endometrial cancer is associated with estrogen exposure (for example, being obese, and also from external or environmental sources of estrogen).

Cadmium is a metal commonly found in foods such as kidneys, liver, and shellfish, but also tobacco (cigarette smoking). Cadmium is toxic, it accumulates in the body, it is an estrogen-mimicking chemical, and it is associated with several hormone-dependent cancers. The researchers found that a doubling of cadmium exposure (as compared to those with low levels) was associated with a 22% increased risk of endometrial cancer.  Bottom line: Go ahead and enjoy these foods, but try to eat foods with naturally high levels of cadmium in moderation - such as shellfish, kidneys, and liver. From Science Daily:

Increased endometrial cancer rates found in women with high levels of cadmium

More than 31,000 new cases of endometrial cancer are expected to be diagnosed in 2017. Through a five-year observational study recently published in PLOS One, researchers at the University of Missouri found that women with increased levels of cadmium -- a metal commonly found in foods such as kidneys, liver and shellfish as well as tobacco -- also had an increased risk of endometrial cancer. It's an observation the researchers hope could lead to new treatments or interventions to prevent the fourth most common cancer in women.

"Cadmium is an estrogen-mimicking chemical, meaning it imitates estrogen and its effects on the body," said lead author Jane McElroy, Ph.D., associate professor in the Department of Family and Community Medicine at the MU School of Medicine. "Endometrial cancer has been associated with estrogen exposure. Because cadmium mimics estrogen, it may lead to an increased growth of the endometrium, contributing to an increased risk of endometrial cancer."

The research team partnered with cancer registries in Missouri, Arkansas and Iowa to identify cases of endometrial cancer. The team enrolled 631 women with a history of endometrial cancer in the study and 879 women without a history of the cancer to serve as a control group. The participants were asked to complete a survey of more than 200 questions about risk factors potentially associated with endometrial cancer. Once they completed the questionnaire, participants were sent a kit to collect urine and saliva samples. Through tests conducted at the MU Research Reactor, the samples were analyzed for cadmium levels.

While more research is needed to better understand the risks associated with cadmium, researchers say there are steps individuals can take to limit their cadmium-associated cancer risks. "We all have cadmium present in our kidneys and livers, but smoking has been shown to more than double a person's cadmium exposure," McElroy said. "Also, we recommend being attentive to your diet, as certain foods such as shellfish, kidney and liver can contain high levels of cadmium. You don't necessarily need to cut these from your diet, but eat them in moderation. This is especially true if women have a predisposition to endometrial cancer, such as a family history, diabetes or obesity." [Original study.]

  Two more studies found that higher levels of vitamin D in the blood are associated with better health outcomes - one study found a lower risk of breast cancer, especially among postmenopausal women, and in the other - better outcomes after a metastatic melanoma diagnosis.

The breast cancer study suggested that a fairly high blood level of vitamin D (25(OH)D serum level>38.0 ng/mL) was associated with a lower risk of breast cancer. But overall they found that women supplementing with vitamin D (more than 4 times a week) at any dose had a lower risk of breast cancer over a 5 year period than those not supplementing with vitamin D. From Environmental Health Perspectives:

Serum Vitamin D and Risk of Breast Cancer within Five Years

Vitamin D is an environmental and dietary agent with known anticarcinogenic effects, but protection against breast cancer has not been established. We evaluated the association between baseline serum 25-hydroxyvitamin D [25(OH)D] levels, supplemental vitamin D use, and breast cancer incidence over the subsequent 5 y of follow-up. From 2003-2009, the Sister Study enrolled 50,884 U.S. women 35-74 y old who had a sister with breast cancer but had never had breast cancer themselves. Using liquid chromatography-mass spectrometry, we measured 25(OH)D in serum samples from 1,611 women who later developed breast cancer and from 1,843 randomly selected cohort participants.

We found that 25(OH)D levels were associated with a 21% lower breast cancer hazard (highest versus lowest quartile). Analysis of the first 5 y of follow-up for all 50,884 Sister Study participants showed that self-reported vitamin D supplementation was associated with an 11% lower hazard. These associations were particularly strong among postmenopausal women.

In this cohort of women with elevated risk, high serum 25(OH)D levels and regular vitamin D supplement use were associated with lower rates of incident, postmenopausal breast cancer over 5 y of follow-up. These results may help to establish clinical benchmarks for 25(OH)D levels; in addition, they support the hypothesis that vitamin D supplementation is useful in breast cancer prevention.

The first sentence in the melanoma study lays out what is widely known: "Vitamin D deficiency (≤20 ng/mL) is associated with an increased incidence and worse prognosis of various types of cancer including melanoma." Studies show that the relationship between vitamin D, sunlight exposure, and melanoma is complicated in a number of ways, including: sun exposure may be associated with increased survival in patients with melanoma. which may mean that vitamin D has a protective role in patients with melanoma. Several studies suggest that vitamin D may delay melanoma recurrence and improve overall prognosis. The study also found that metastatic melanoma patients with vitamin D deficiency who are unable to or don't raise their vitamin D blood levels (25(OH)D3) have a worse outcome compared to those who are are able to markedly increase (by greater than >20 ng/mL) their 25(OH)D3 levels. From Oncotarget:

Vitamin D deficiency is associated with a worse prognosis in metastatic melanoma

Vitamin D deficiency (≤20 ng/mL) is associated with an increased incidence and worse prognosis of various types of cancer including melanoma. A retrospective, single-center study of individuals diagnosed with melanoma from January 2007 through June 2013 who had a vitamin D (25(OH)D3) level measured within one year of diagnosis was performed to determine whether vitamin D deficiency and repletion are associated with melanoma outcome.

A total of 409 individuals diagnosed with histopathology-confirmed melanoma who had an ever measured serum 25(OH)D3 level were identified. 252 individuals with a 25(OH)D3 level recorded within one year after diagnosis were included in the study .... A worse melanoma prognosis was associated with vitamin D deficiency, higher stage, ulceration, and higher mitotic rate. In patients with stage IV metastatic melanoma, vitamin D deficiency was associated with significantly worse melanoma-specific mortality. Patients with metastatic melanoma who were initially vitamin D deficient and subsequently had a decrease or ≤20 ng/mL increase in their 25(OH)D3 concentration had significantly worse outcomes compared to non-deficient patients who had a >20 ng/mL increase. Our results suggest that initial vitamin D deficiency and insufficient repletion is associated with a worse prognosis in patients with metastatic melanoma.

  I've frequently mentioned that when taking vitamin D supplements, the one to take is vitamin D3, and not D2. Medscape (the medical site) has an article explaining that results of a recent study showed that vitamin D3 is twice as effective as D2 in raising blood levels of vitamin D. The vitamin D3 form is derived from animal products, while vitamin D2 is plant-based. So check any supplements you purchase because many contain the vitamin D2 form of vitamin D.

Of course, sunlight is the best because it has more benefits than vitamin D - such as also having low levels of "blue light" which energizes T cells (which are part of the immune system). From Medscape:

Vitamin D3, Not D2, Is Key to Tackling Vitamin D Deficiency

Vitamin D3 is significantly more effective at raising the serum biological marker of vitamin D status than vitamin D2 when given at standard doses in everyday food and drink, say UK researchers — findings that could have major implications for both current guidelines and the supplement industry.

In a randomized controlled trial of vitamin D supplements, vitamin D3, which is derived from animal products, was associated with significantly higher serum total 25-hydroxyvitamin D [25(OH)D] levels after 12 weeks than vitamin D2, which is plant-based and currently used in the vast majority of vitamin D supplements.

"The importance of vitamin D in our bodies is not to be underestimated, but living in the UK it is very difficult to get sufficient levels from its natural source, the sun, so we know it has to be supplemented through our diet," explained lead author Laura Tripkovic, PhD, department of nutritional sciences, University of Surrey, Guildford, United Kingdom, in a press release.

She added, "Our findings show that vitamin D3 is twice as effective as D2 in raising vitamin D levels in the body, which turns current thinking about the two types of vitamin D on its head." "Those who consume D3 through fish, eggs, or vitamin D3-containing supplements are twice as likely to raise their vitamin D status [compared with those] consuming vitamin Drich foods, such as mushrooms, vitamin Dfortified bread, or vitamin Dcontaining supplements, helping to improve their long-term health." [Original study.]